Changes

===Abstract ===

===Abstract ===

 

The chapter [[Varnasvariyamindriyam Adhyaya]] is about ''arishta lakshana'' (near death signs) perceived by auditory and visual senses. ''Swara'' (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of ''arishtas'' are described in the chapter.

The chapter [[Varnasvariyamindriyam Adhyaya]] is about ''arishta lakshana'' (near death signs) perceived by auditory and visual senses. ''Swara'' (Voice) is an audible feature, whereas color and complexion are visual features. Sudden change in frequency, rhythm, resonance, tone, the pitch of voice and complexion of the body is indicative of serious pathology of the body. The characteristic features of ''arishtas'' are described in the chapter.

'''Keywords''': Near death signs, change in voice, change in complexion.

'''Keywords''': Near death signs, change in voice, change in complexion.

 

===Introduction ===

===Introduction ===

 

Charaka has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this first chapter of [[Indriya Sthana]], [[Varnasvariyamindriyam Adhyaya]], Charaka mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''prakriti'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling with etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

Charaka has placed [[Indriya Sthana]] (section about near death signs) before [[Chikitsa Sthana]] (section about the treatment of diseases) possibly, to guide physician when not to treat a patient. In this first chapter of [[Indriya Sthana]], [[Varnasvariyamindriyam Adhyaya]], Charaka mentions near death signs and symptoms that can be directly observed by visual and other faculties. This chapter also describes ''prakriti'', the natural disposition of an individual, and ''vikriti'', or abnormalities , since such knowledge helps in discerning any sign of ''vikriti'' in a "healthy" individual. Three types of morbid conditions are observed namely, ''lakshana nimitta'', caused by bodily marks, ''lakshya nimitta'', caused by etiological factors which disturb the health, and ''nimitta anuroopa vikriti'', a break down for no apparent reason resembling with etiological factors. The chapter describes various near death signs with changes in color, the complexion of body parts and voice.

 

===Sanskrit text, Transliteration and English Translation===

===Sanskrit text, Transliteration and English Translation===

iha khalu varNashca svarashca gandhashca rasashca sparshashca cakShushca shrotraM ca ghrANaM carasanaM ca sparshanaM ca sattvaM ca bhaktishca shaucaM ca shIlaM cAcArashca smRutishcAkRutishcaprakRutishca vikRutishca balaM ca glAnishca medhA ca harShashca raukShyaM ca snehashca tandrAcArambhashca gauravaM ca lAghavaM ca guNAshcAhArashcavihArashcAhArapariNAmashcopAyashcApAyashca vyAdhishca vyAdhipUrvarUpaM cavedanAshcopadravAshca cchAyA ca praticchAyA ca svapnadarshanaM ca dUtAdhikArashca pathicautpAtikaM cAturakule bhAvAvasthAntarANi ca bheShajasaMvRuttishca  bheShajavikArayuktishcetiparIkShyANi pratyakShAnumAnopadeshairAyuShaH pramANAvasheShaM jij~jAsamAnena bhiShajA||3||  

iha khalu varNashca svarashca gandhashca rasashca sparshashca cakShushca shrotraM ca ghrANaM carasanaM ca sparshanaM ca sattvaM ca bhaktishca shaucaM ca shIlaM cAcArashca smRutishcAkRutishcaprakRutishca vikRutishca balaM ca glAnishca medhA ca harShashca raukShyaM ca snehashca tandrAcArambhashca gauravaM ca lAghavaM ca guNAshcAhArashcavihArashcAhArapariNAmashcopAyashcApAyashca vyAdhishca vyAdhipUrvarUpaM cavedanAshcopadravAshca cchAyA ca praticchAyA ca svapnadarshanaM ca dUtAdhikArashca pathicautpAtikaM cAturakule bhAvAvasthAntarANi ca bheShajasaMvRuttishca  bheShajavikArayuktishcetiparIkShyANi pratyakShAnumAnopadeshairAyuShaH pramANAvasheShaM jij~jAsamAnena bhiShajA||3||  

 

The following entities should be examined by the physician desiring to assess the residual span of life of the patient using direct observation, and inference such as:

The following entities should be examined by the physician desiring to assess the residual span of life of the patient using direct observation, and inference such as:

*Physical appearance (complexion, appearance of eyes, ears, nose, tongue, skin), including attributes perceived by the senses (voice, smell, taste, touch, etc.)

*Physical appearance (complexion, appearance of eyes, ears, nose, tongue, skin), including attributes perceived by the senses (voice, smell, taste, touch, etc.)

Bad omens perceived by the physician on his way to patient's house, changed conditions of the patient's residence, signs and symptoms indicating the residual span of life may be evident on these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice. [3]

Bad omens perceived by the physician on his way to patient's house, changed conditions of the patient's residence, signs and symptoms indicating the residual span of life may be evident on these factors. Hence physician should pay careful attention to each one of them and interpretation should be made based on his observations, knowledge and scriptural advice. [3]

 

तत्र तु खल्वेषां परीक्ष्याणां कानिचित् पुरुषमनाश्रितानि, कानिचिच्च पुरुषसंश्रयाणि|  

तत्र तु खल्वेषां परीक्ष्याणां कानिचित् पुरुषमनाश्रितानि, कानिचिच्च पुरुषसंश्रयाणि|  

तत्र यानि पुरुषमनाश्रितानि तान्युपदेशतो युक्तितश्च परीक्षेत, पुरुषसंश्रयाणि पुनः प्रकृतितोविकृतितश्च||४||  

तत्र यानि पुरुषमनाश्रितानि तान्युपदेशतो युक्तितश्च परीक्षेत, पुरुषसंश्रयाणि पुनः प्रकृतितोविकृतितश्च||४||  

tatra tu khalveShAM parIkShyANAM kAnicit puruShamanAshritAni, kAnicicca puruShasaMshrayANi|  

tatra tu khalveShAM parIkShyANAM kAnicit puruShamanAshritAni, kAnicicca puruShasaMshrayANi|  

tatra yAni puruShamanAshritAni tAnyupadeshato yuktitashca parIkSheta, puruShasaMshrayANi punaHprakRutito vikRutitashca||4||

tatra yAni puruShamanAshritAni tAnyupadeshato yuktitashca parIkSheta, puruShasaMshrayANi punaHprakRutito vikRutitashca||4||

 

Out of these entities, some are not seated in a patient but are about patients. Those who are not seated in patients are required to be examined with logic based on scriptural instructions and inference. Those which can be seen in patients are examined by observing their constitution and morbid conditions. The factors not seated in patients are often circumstantial like an informer who comes with news of patient and the good/bad omens seen by the physician. But all these factors should be assessed wisely in the quest for the life of the patient. [4]

Out of these entities, some are not seated in a patient but are about patients. Those who are not seated in patients are required to be examined with logic based on scriptural instructions and inference. Those which can be seen in patients are examined by observing their constitution and morbid conditions. The factors not seated in patients are often circumstantial like an informer who comes with news of patient and the good/bad omens seen by the physician. But all these factors should be assessed wisely in the quest for the life of the patient. [4]

 

==== Factors responsible for natural constitution ====  

==== Factors responsible for natural constitution ====  

tatra prakRutirjAtiprasaktA ca, kulaprasaktA ca, deshAnupAtinI  ca, kAlAnupAtinI ca vayo~anupAtinI ca, pratyAtmaniyatA ceti|  

tatra prakRutirjAtiprasaktA ca, kulaprasaktA ca, deshAnupAtinI  ca, kAlAnupAtinI ca vayo~anupAtinI ca, pratyAtmaniyatA ceti|  

jAtikuladeshakAlavayaHpratyAtmaniyatA hi teShAM teShAM puruShANAM te te bhAvavisheShAbhavanti||5||  

jAtikuladeshakAlavayaHpratyAtmaniyatA hi teShAM teShAM puruShANAM te te bhAvavisheShAbhavanti||5||  

 

The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, place of living, season, age and individual habits.[5]

The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, place of living, season, age and individual habits.[5]

 

==== Types of pathological abnormalities ====

==== Types of pathological abnormalities ====

   

   

tatra lakShaNanimittA nAma sA yasyAH sharIre lakShaNAnyeva hetubhUtAni bhavanti daivAt; lakShaNAni hi kAniciccharIropanibaddhAni bhavanti, yAni hitasmiMstasmin kAle tatrAdhiShThAnamAsAdya tAM tAM vikRutimutpAdayanti|7|  

tatra lakShaNanimittA nAma sA yasyAH sharIre lakShaNAnyeva hetubhUtAni bhavanti daivAt; lakShaNAni hi kAniciccharIropanibaddhAni bhavanti, yAni hitasmiMstasmin kAle tatrAdhiShThAnamAsAdya tAM tAM vikRutimutpAdayanti|7|  

 

The pathological conditions based on symptoms are those, whose causative factors are pre-determined by destiny in the form of physiognomic signs. Some of these signs may be latent in the body, and appear at particular time in particular parts of body giving rise to particular related morbid conditions. [7[1]]

The pathological conditions based on symptoms are those, whose causative factors are pre-determined by destiny in the form of physiognomic signs. Some of these signs may be latent in the body, and appear at particular time in particular parts of body giving rise to particular related morbid conditions. [7[1]]

 

लक्ष्यनिमित्ता तु सा यस्या उपलभ्यते निमित्तं यथोक्तं  निदानेषु|७|

लक्ष्यनिमित्ता तु सा यस्या उपलभ्यते निमित्तं यथोक्तं  निदानेषु|७|

ityuddeshaH|  

ityuddeshaH|  

taM vistareNAnuvyAkhyAsyAmaH||7||

taM vistareNAnuvyAkhyAsyAmaH||7||

 

The pathological conditions based upon the factors that appear to behave like etiological factors is that which resembles the conditions brought about by etiological factors. It is the undetermined pathological condition which the physicians regard as the determination in the ascertainment of the remaining lifespan. It is furthermore the pathological condition resulting from exhaustion of life-measure and resembling a corpse-like appearance, that the wise delineate for the purpose of ascertaining the remaining portion of life-span. It is the reference to this condition that we shall set out the signs and symptoms observed in the body of the patient who is fated to die. This is the summary. We shall explain in detail. [7[3]]

The pathological conditions based upon the factors that appear to behave like etiological factors is that which resembles the conditions brought about by etiological factors. It is the undetermined pathological condition which the physicians regard as the determination in the ascertainment of the remaining lifespan. It is furthermore the pathological condition resulting from exhaustion of life-measure and resembling a corpse-like appearance, that the wise delineate for the purpose of ascertaining the remaining portion of life-span. It is the reference to this condition that we shall set out the signs and symptoms observed in the body of the patient who is fated to die. This is the summary. We shall explain in detail. [7[3]]

 

==== Normal complexion ====

==== Normal complexion ====

   

   

iti prakRutivikRutivarNA bhavantyuktAH sharIrasya|  

iti prakRutivikRutivarNA bhavantyuktAH sharIrasya|  

tatra prakRutivarNamardhasharIre vikRutivarNamardhasharIre, dvAvapi varNau maryAdAvibhaktau dRuShTvA; yadyevaM savyadakShiNavibhAgena, yadyevaMpUrvapashcimavibhAgena, yadyuttarAdharavibhAgena, yadyantarbahirvibhAgena, AturasyAriShTamiti vidyAt; evameva varNabhedo mukhe~apyanyatra [3] vartamAnomaraNAya bhavati||9||  

tatra prakRutivarNamardhasharIre vikRutivarNamardhasharIre, dvAvapi varNau maryAdAvibhaktau dRuShTvA; yadyevaM savyadakShiNavibhAgena, yadyevaMpUrvapashcimavibhAgena, yadyuttarAdharavibhAgena, yadyantarbahirvibhAgena, AturasyAriShTamiti vidyAt; evameva varNabhedo mukhe~apyanyatra [3] vartamAnomaraNAya bhavati||9||  

 

The unnatural or pathological complexions include blue, blackish, coppery, green and snow white. Similarly, there are some other unnatural types of complexion which appear suddenly for unknown reason. These are the normal and abnormal complexions of body.  

The unnatural or pathological complexions include blue, blackish, coppery, green and snow white. Similarly, there are some other unnatural types of complexion which appear suddenly for unknown reason. These are the normal and abnormal complexions of body.  

Normal complexion in one half of the body and abnormal complexion in the other half and both are demarcated clearly by a line, same abnormality on left and right side of body, front and back side of body, upper and lower or internal and external parts of the body is considered ''arishta'' (near to death signs). Such demarcation abnormality on face and other parts too indicates death. [9]

Normal complexion in one half of the body and abnormal complexion in the other half and both are demarcated clearly by a line, same abnormality on left and right side of body, front and back side of body, upper and lower or internal and external parts of the body is considered ''arishta'' (near to death signs). Such demarcation abnormality on face and other parts too indicates death. [9]

 

वर्णभेदेन ग्लानिहर्षरौक्ष्यस्नेहा व्याख्याताः||१०||  

वर्णभेदेन ग्लानिहर्षरौक्ष्यस्नेहा व्याख्याताः||१०||  

yaccAnyadapi ki~jcidvarNavaikRutamabhUtapUrvaM sahasotpadyetAnimittameva hIyamAnasyAturasya shashvat, tadariShTamiti vidyAt|  

yaccAnyadapi ki~jcidvarNavaikRutamabhUtapUrvaM sahasotpadyetAnimittameva hIyamAnasyAturasya shashvat, tadariShTamiti vidyAt|  

iti varNAdhikAraH||13||  

iti varNAdhikAraH||13||  

 

Sudden appearance of any one of the abnormal colors in nails, eyes, face, urine, stool, hands, legs and lips together with diminished strength, complexion and senses indicate imminent death. Such other abnormal complexions too that appear suddenly for the first time without any apparent cause in the patient with constant deterioration of health are the signs of death. [12-13]

Sudden appearance of any one of the abnormal colors in nails, eyes, face, urine, stool, hands, legs and lips together with diminished strength, complexion and senses indicate imminent death. Such other abnormal complexions too that appear suddenly for the first time without any apparent cause in the patient with constant deterioration of health are the signs of death. [12-13]

 

==== Normal and abnormal voice ====

==== Normal and abnormal voice ====

eDakakalagrastAvyaktagadgadakShAmadInAnukIrNAstvAturANAM [2] svarA vaikArikA bhavanti; yAMshcAparAnupekShamANo~api [3] vidyAtprAgvikRutAnabhUtvotpannAn [4] |  

eDakakalagrastAvyaktagadgadakShAmadInAnukIrNAstvAturANAM [2] svarA vaikArikA bhavanti; yAMshcAparAnupekShamANo~api [3] vidyAtprAgvikRutAnabhUtvotpannAn [4] |  

iti prakRutivikRutisvarA vyAkhyAtA bhavanti||14||  

iti prakRutivikRutisvarA vyAkhyAtA bhavanti||14||  

 

The normal human voice resembles the voice of ''hamsa'' (swan), ''krauncha'' (demoiselle crane), ''nemi'' (wheel), ''dundubhi'' (kettle drum), ''kalavinka'' (house sparrow), ''kaka'' (crow), ''kapota'' (dove) and jarjara (a type of drum).

The normal human voice resembles the voice of ''hamsa'' (swan), ''krauncha'' (demoiselle crane), ''nemi'' (wheel), ''dundubhi'' (kettle drum), ''kalavinka'' (house sparrow), ''kaka'' (crow), ''kapota'' (dove) and jarjara (a type of drum).

The voice of person with disease resembles that of sheep and is feeble, inaudible, indistinct, choked, hoarse, painful and stammering.  Thus normal and abnormal voices are described. [14]

The voice of person with disease resembles that of sheep and is feeble, inaudible, indistinct, choked, hoarse, painful and stammering.  Thus normal and abnormal voices are described. [14]

तत्र प्रकृतिवैकारिकाणां स्वराणामाश्वभिनिर्वृत्तिः स्वरानेकत्वमेकस्य  चानेकत्वमप्रशस्तम्| इतिस्वराधिकारः||१५||  

तत्र प्रकृतिवैकारिकाणां स्वराणामाश्वभिनिर्वृत्तिः स्वरानेकत्वमेकस्य  चानेकत्वमप्रशस्तम्| इतिस्वराधिकारः||१५||  

yaccAnyadapi ki~jcit syAdvaikRutaM svaravarNayoH|  

yaccAnyadapi ki~jcit syAdvaikRutaM svaravarNayoH|  

balamAMsavihInasya tat sarvaM maraNodayam  ||25||

balamAMsavihInasya tat sarvaM maraNodayam  ||25||

 

If half of the face there is blue, blackish, coppery or tawny color and the color of the remaining half is otherwise. Manifestation of unctuousness in one half of the face and roughness in the other half is inauspicious.

If half of the face there is blue, blackish, coppery or tawny color and the color of the remaining half is otherwise. Manifestation of unctuousness in one half of the face and roughness in the other half is inauspicious.

Such other abnormalities in voice and complexion of an individual who is devoid of strength and flesh also indicate imminent death.[17-25]

Such other abnormalities in voice and complexion of an individual who is devoid of strength and flesh also indicate imminent death.[17-25]

 

तत्रश्लोकः-  

तत्रश्लोकः-  

इतिवर्णस्वरावुक्तौलक्षणार्थंमुमूर्षताम्|यस्तौसम्यग्विजानाति नायुर्ज्ञाने स मुह्यति||२६||  

इतिवर्णस्वरावुक्तौलक्षणार्थंमुमूर्षताम्|यस्तौसम्यग्विजानाति नायुर्ज्ञाने स मुह्यति||२६||  

=== ''Tattva Vimarsha'' ===  

=== ''Tattva Vimarsha'' ===  

 

*The prognosis of disease leading to death can be predicted by keen observation of complexion, color of body parts and voice. [3]

*The prognosis of disease leading to death can be predicted by keen observation of complexion, color of body parts and voice. [3]

*The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, palce of living, season, age and individual habits. [5]

*The natural constitution of a person depends upon ''Jati'' (caste), ''Kula'' (race), ''Desha'' (place), ''Kala'' (time and season), ''Vaya'' (age), ''Pratyatmaniyata'' (individual habits and habitat). The different variations seen in persons are based upon their caste, race, palce of living, season, age and individual habits. [5]

**In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.

**In laryngeal tumors like supra glottic cancer  and glottis cancer hoarseness of voice is a late symptom.

In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Central and peripheral cyanosis represents certain death causing conditions. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia shows underlining pathologies which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.

In fact the abnormal changes in color and voice of the patient reflect serious changes in the physiology. Deep seated pathologies of cardio vascular system, Respiratory system, endocrine system often presents with color changes. Central and peripheral cyanosis represents certain death causing conditions. Similarly lesions in the central nervous system can lead to changes in the voice. Dysarthria, Dysphasia and Dysphonia shows underlining pathologies which may become fatal. In short this chapter highlights the events related with major systems in the body which can cause death.